92 Decision Citation: BVA 92-21553
Y92
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 90-23 983 ) DATE
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THE ISSUE
Entitlement to service connection for recurrent aphthous
stomatitis, a back disorder, and the residuals of an injury
of the right thumb and index finger.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
Joseph P. Gervasio, Jr., Counsel
INTRODUCTION
This matter came before the Board of Veterans' Appeals
(Board) from an August 1989 rating action of the
St. Petersburg, Florida, Regional Office (RO) of the
Department of Veterans Affairs (VA). The veteran served on
active duty from November 1981 to May 1989.
The veteran's notice of disagreement was received by the RO
in November 1989. The statement of the case was issued in
January 1990 and the substantive appeal was received in
April 1990. The case was remanded by the Board in a
December 1990 decision. The RO continued to deny the
claims, and a supplemental statement of the case was issued
in October 1991. The case was returned to the Board in
March 1992. The veteran's representative, Disabled American
Veterans, submitted additional argument on appeal in March
1992.
The issues of entitlement to service connection for a back
disorder and the residuals of a right thumb and index finger
injury will be dealt with in the remand portion of this
decision. The main portion of our decision addresses the
issue of service connection for recurrent aphthous
stomatitis (claimed as mouth ulcerations).
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends that service connection is warranted
for recurrent mouth ulcerations. It is asserted that the
veteran was treated for ulcerations during service and that
he continues to have this disorder.
DECISION OF THE BOARD
In accordance with the provisions of 38 U.S.C. § 7104,
following review and consideration of all evidence and
material of record in the veteran's claims file, and for the
following reasons and bases, it is the decision of the Board
that the preponderance of the evidence supports the grant of
service connection for recurrent aphthous stomatitis.
FINDING OF FACT
The veteran has recurrent aphthous stomatitis which began
during active military service.
CONCLUSION OF LAW
Recurrent aphthous stomatitis was incurred during active
military service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §
3.303 (1991).
REASONS AND BASES FOR FINDING AND CONCLUSIONS
We find the claim for service connection for aphthous
stomatitis, or mouth ulcerations, to be well grounded within
the meaning of 38 U.S.C. § 5107. That is, the claim is not
inherently implausible. It is also noted that, following
the Board's last remand, the VA has fulfilled its duty to
assist in the development of this claim. 38 U.S.C. § 5107.
In order to establish service connection for a claimed
disability, the facts, as shown by evidence, must
demonstrate that a particular disease or injury resulting in
current disability was incurred in or aggravated by active
service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303.
On examination for enlistment into active duty, performed in
February 1981, no dental abnormality was described and the
veteran stated that he had not had any severe tooth or gum
trouble. Service dental records show no abnormality upon
the initial dental processing performed in November 1981.
Dental records show that, in April 1982, the veteran was
given ointment for ulcerative mouth lesions. The dental
records show dental treatment, but no further mention of
mouth ulcers until February 1984 when the veteran was given
medication for recurrent aphthous ulcers. His medication
was refilled in March 1984 and in July 1984 he was treated
for complaints of ulcerations that recurred, lasted
approximately one week, and had an appearance consistent
with aphthous ulcers. Dental records show additional
treatment for this disorder in July, November,and December
1988.
An examination was performed for the VA in July 1989. At
that time, examination of the oral cavity did not reveal the
presence of any ulcerations either around the lips or inside
the oral cavity. The diagnostic impression, apparently
based on history, was chronic and recurring ulcerations of
the mouth. A second examination was performed by the VA in
September 1991. At that time, examination of the oral
cavity revealed three shallow whitish ulcerations ranging
from 2 to 3 millimeters in diameter noted on the upper
gingival mucosa anteriorly, on the upper gingival mucosa on
the right side opposite to the last molar, and on the lower
gingival mucosa on the right side inferior to the last
molar. Tenderness was elicited on light pressure on the
described mucosal lesions. The pertinent impression was
chronic recurrent stomatitis, etiology unknown.
Recurrent aphthous stomatitis is a recurrent disease of
unknown etiology, characterized by the appearance on the
oral mucosa of one or more small round or oval ulcers that
are covered by a grayish fibrinous exudate and surrounded by
a bright red halo. The lesions usually persist for 7 to
14 days and then heal without scarring. Dorland's
Illustrated Medical Dictionary, 1586 (27th ed. 1988). The
veteran was treated for lesions that were considered
consistent with aphthous ulcers during service, and which
appear to be related to the stomatitis demonstrated on
examination by the VA in September 1991. Even if, as
suggested by the RO, the veteran's stomatitis represents
Vincent's disease, a finding of service incurrence is
consistent with 38 C.F.R. §3.382, given the entire evidence
in this case. Under these circumstances, service connection
is warranted.
ORDER
Service connection for recurrent aphthous stomatitis is
granted.
REMAND
The VA has a duty to assist the veteran in developing facts
pertinent to claims which are well grounded. 38 U.S.C.
§ 5107(a); 38 C.F.R. §§ 3.103(a), 3.159 (1991). This duty
includes, when indicated by the circumstances of the case,
ordering a medical examination. Littke v. Derwinski, 1
Vet.App. 90 (1990).
A review of the record shows that the veteran was treated
for episodes of thoracic spine pain during his service. On
examination by the VA in September 1991 he was again
diagnosed as having chronic recurrent upper back pain
(thoracic). At that time, X-ray studies of the thoracic
spine were planned. However, if these studies were
accomplished, a report is not of record. In view of the
duty to assist the veteran in the development of facts
pertinent to his appeal, we find that a report of the X-ray
examinations should be made a part of the claims file prior
to final appellate consideration. If the X-ray reports is
not located, another examination should be provided. The
case is being REMANDED for the following:
The RO should ascertain whether X-ray
studies of the thoracic spine were
accomplished in connection with the
September 1991 VA examination. If such
studies were conducted, a report should
be obtained. If the studies were not
conducted, the RO should arrange for the
veteran to undergo another examination of
the thoracic spine, which should include
X-ray studies, in an attempt to ascertain
the cause of his recurrent thoracic
pain.
When this action is completed, the claim for service
connection for a back disorder should be reviewed by the
RO. Should the decision remain adverse, the veteran and his
representative should be furnished a supplemental statement
of the case and afforded a reasonable opportunity to
respond. Thereafter, the case should be returned to this
Board for further appellate consideration. The remaining
issue on appeal must be held in abeyance until the above
development has been completed. The appellant need take no
action unless he is notified.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
STEPHEN A. JONES (Member temporarily absent)
L. W. TOBIN
*38 U.S.C. § 7102(a)(2)(A) (1992) permits a Board of
Veterans' Appeals Section, upon direction of the Chairman of
the Board, to proceed with the transaction of business
without awaiting assignment of an additional Member to the
Section when the Section is composed of fewer than three
Members due to absence of a Member, vacancy on the Board or
inability of the Member assigned to the Section to serve on
the panel. The Chairman has directed that the Section
proceed with the transaction of business, including the
issuance of decisions, without awaiting the assignment of a
third Member.
Under 38 U.S.C. § 7252 (1992), only a decision of the Board
of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of
a preliminary order and does not constitute a decision of
the Board on the merits of your appeal.